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European Radiology

, Volume 24, Issue 1, pp 12–18 | Cite as

A new-generation, low-permeability flow diverting device for treatment of saccular aneurysms

  • Ajit S. Mallik
  • Katja Nuss
  • Peter W. Kronen
  • Karina Klein
  • Agnieszka Karol
  • Brigitte von Rechenberg
  • Daniel A. Rüfenacht
  • Isabel Wanke
  • Zsolt KulcsárEmail author
Neuro

Abstract

Objectives

We report a preclinical comparative study of a 96-strand braided flow diverter.

Methods

The 96-strand braided device was compared with the currently commercially available flow diverter with 48 strands. The devices were implanted across the neck of 12 elastase-induced aneurysms in New Zealand White rabbits and followed for 1 and 3 months (n = 6 respectively). Aneurysm occlusion rates, parent artery stenosis and patency of jailed branch occlusions were assessed by angiography, histology and scanning electron microscopy studies.

Results

It was feasible to navigate and implant the 96-strand device over the aneurysm orifice in all cases. At follow-up two aneurysms in the 48-strand vs. one in the 96-strand group were not occluded. This aneurysm from the 96-strand group however had a tracheal branch arising from the sac and showed a reverse remodelling of the vascular pouch at 3 months. In the occluded aneurysms, the parent artery was always completely reconstructed and the aneurysm orifice was sealed with neointimal tissue. No in-stent stenosis or jailed branch artery occlusion was observed.

Conclusions

The 96-strand flow diverter proved to be safe, biocompatible and haemodynamically effective, induced stable occlusion of aneurysms and led to reverse remodelling of the parent artery.

Key points

• Flow diversion has been introduced to improve endovascular treatment of cerebral aneurysms

• A new low-permeability flow diverter is feasible for parent artery reconstruction.

• The Silk 96 flow diverter appears effective at inducing aneurysm healing.

• The covered branches remained patent at follow-up.

Keywords

Flow diverter Aneurysm Stenting Thrombus Porosity Pore density 

Abbreviations

CCA

Common carotid artery

DSA

Digital subtracted angiography

FD

Flow diverter

PA

Parent artery

SEM

Scanning electron microscopy

VA

Vertebral artery

Notes

Acknowledgements

Zsolt Kulcsár and Isabel Wanke are proctors for Silk implantation.This work was partially supported by a grant from the Swiss National Science Foundation (SNSF) (CR32I3-127008). The work was partially funded by Balt International. Balt International had no editorial authority in the drafting or editing of this article.

References

  1. 1.
    Geremia G, Haklin M, Brennecke L (1994) Embolization of experimentally created aneurysms with intravascular stent devices. AJNR Am J Neuroradiol 15:1223–1231PubMedGoogle Scholar
  2. 2.
    Baráth K, Cassot F, Fasel JH, Ohta M, Rüfenacht DA (2005) Influence of stent properties on the alteration of cerebral intra-aneurysmal haemodynamics: flow quantification in elastic sidewall aneurysm models. Neurol Res 27(Suppl 1):S120–S128PubMedCrossRefGoogle Scholar
  3. 3.
    Lieber BB, Stancampiano AP, Wakhloo AK (1997) Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 25:460–469PubMedCrossRefGoogle Scholar
  4. 4.
    Yu SC, Zhao JB (1999) A steady flow analysis on the stented and non-stented sidewall aneurysm models. Med Eng Phys 21:133–141PubMedCrossRefGoogle Scholar
  5. 5.
    Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF (2013) Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 44:442–447PubMedCrossRefGoogle Scholar
  6. 6.
    Kulcsár Z, Houdart E, Bonafé A et al (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:20–25PubMedGoogle Scholar
  7. 7.
    Kulcsár Z, Szikora I (2012) The ESMINT Retrospective Analysis of Delayed Aneurysm Ruptures after flow diversion (RADAR) study. EJMINT 1244000078Google Scholar
  8. 8.
    Altes TA, Cloft HJ, Short JG et al (2000) Creation of saccular aneurysms in the rabbit a model suitable for testing endovascular devices. AJR Am J Roentgenol 174:349–354PubMedCrossRefGoogle Scholar
  9. 9.
    Kamran M, Yarnold J, Grunwald IQ, Byrne JV (2011) Assessment of angiographic outcomes after flow diversion treatment of intracranial aneurysms: a new grading schema. Neuroradiology 53:501–508PubMedCrossRefGoogle Scholar
  10. 10.
    Ding YH, Dai D, Lewis DA et al (2005) Intra-venous digital subtraction angiography: an alternative method to intra-arterial digital subtraction angiography for experimental aneurysm imaging. Neuroradiology 47:792–795PubMedCrossRefGoogle Scholar
  11. 11.
    Berge J, Biondi A, Machi P et al (2012) Flow-diverter Silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. AJNR Am J Neuroradiol 33:1150–1155PubMedCrossRefGoogle Scholar
  12. 12.
    Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M (2010) Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5(pii):e12492PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Deutschmann HA, Wehrschuetz M, Augustin M, Niederkorn K, Klein GE (2012) Long-term follow-up after treatment of intracranial aneurysms with the pipeline embolization device: results from a single center. AJNR Am J Neuroradiol 33:481–486PubMedCrossRefGoogle Scholar
  14. 14.
    Fischer S, Vajda Z, Aguilar Perez M et al (2012) Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology 54:369–382PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Lylyk P, Miranda C, Ceratto R et al (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632–642, discussion 642–3; quiz N6PubMedCrossRefGoogle Scholar
  16. 16.
    Szikora I, Berentei Z, Kulcsar Z et al (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31:1139–1147PubMedCrossRefGoogle Scholar
  17. 17.
    Byrne JV, Szikora I (2012) Flow diverters in the management of intracranial aneurysms: a review. EJMINT 1225000057Google Scholar
  18. 18.
    Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge HS (2012) Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. AJNR Am J Neuroradiol 33:1436–1446PubMedCrossRefGoogle Scholar
  19. 19.
    Sadasivan C, Cesar L, Seong J et al (2009) An original flow diversion device for the treatment of intracranial aneurysms: evaluation in the rabbit elastase-induced model. Stroke 40:952–958PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Kallmes DF, Ding YH, Dai D, Kadirvel R, Lewis DA, Cloft HJ (2009) A second-generation, endoluminal, flow-disrupting device for treatment of saccular aneurysms. AJNR Am J Neuroradiol 30:1153–1158PubMedCrossRefGoogle Scholar
  21. 21.
    Seshadhri S, Janiga G, Beuing O, Skalej M, Thévenin D (2011) Impact of stents and flow diverters on hemodynamics in idealized aneurysm models. J Biomech Eng 133:071005PubMedCrossRefGoogle Scholar
  22. 22.
    Wolberg AS, Aleman MM, Leiderman K, Machlus KR (2012) Procoagulant activity in hemostasis and thrombosis: Virchow’s triad revisited. Anesth Analg 114:275–285PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Frösen J, Tulamo R, Paetau A et al (2012) Saccular intracranial aneurysm: pathology and mechanisms. Acta Neuropathol 123:773–786PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Ajit S. Mallik
    • 1
  • Katja Nuss
    • 2
  • Peter W. Kronen
    • 1
    • 2
    • 3
  • Karina Klein
    • 2
  • Agnieszka Karol
    • 2
  • Brigitte von Rechenberg
    • 1
    • 2
  • Daniel A. Rüfenacht
    • 1
    • 4
  • Isabel Wanke
    • 1
    • 4
    • 5
  • Zsolt Kulcsár
    • 1
    • 4
    Email author
  1. 1.Center of Applied Biotechnology and Molecular MedicineUniversity of ZurichZurichSwitzerland
  2. 2.Musculoskeletal Research UnitEquine Hospital, Vetsuisse Faculty, University of ZurichZurichSwitzerland
  3. 3.Veterinary Anaesthesia Services-InternationalWinterthurSwitzerland
  4. 4.Department of NeuroradiolgySwiss Neuro Institute, Hirslanden ClinicZurichSwitzerland
  5. 5.Institute of Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital of EssenEssenGermany

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